Class Registration

Select a Class*

Are you a qualifying member? Did you work the required volunteer hours within the last 12 months?

Yes

No

Please check yes in this field ONLY if you are entitled to membership discounts. (ONLY OTCPBC MEMBERS WHO HAVE WORKED 20 HOURS within the last twelve months are eligible.) If you do not, you will be charged the nonmember rate. New members are NOT eligible for discounts until they have worked 20 volunteer hours. Discounts apply when volunteer hours have been recorded and published in Lead Lines.

Name*

FirstLast

Address

Street AddressAddress Line 2CityStateZIP Code

Primary Contact Number*

Home

Work

Cell

Preferred Phone*

Email*

Dog's Name*

Breed*

Color

Sex*

Age*

Date of Last Distemper/Parvo Vaccination or Titer

Date Format: MM slash DD slash YYYY

Date of Last Rabies or Titer

Date Format: MM slash DD slash YYYY

Does your dog have any injuries or medical conditions?

No

Yes

Explain

Does your dog bark and lunge when on leash and around other dogs? Has your dog ever been in a fight resulting in injury to himself or others?

No

Yes

Explain

Has your dog ever tried to bite a person or other dog?

No

Yes

Explain

Name

Hold Harmless True and Accurate and Signature*

I affirm that the information I have entered is correct, including information on my dog's behavior around other dogs. My dog's veterinary records will reflect the dates submitted above. In case of accident or injury to my dog or myself, including dog bites, I hold harmless Obedience Training Club of Palm Beach County (OTCPBC), its instructors, and its Board of Directors, from any claim or liability resulting from said accident or injury. I understand that animals, including my own dog(s), are unpredictable and that dog sports by nature are not without risk.

Club Class Policies - Sign and Acknowledge Below*

Refunds: Because class size is limited and sufficient time is necessary to contact alternate students, class tuition may only be refunded if notice, in writing or by email, is received seven (7) business days prior to the start date of a class by the instructor or the director. OTCPBC does not offer make-up lessons, private instruction in lieu of group classes, or transfers of monies from one class to another. Seminar fees are nonrefundable unless there is a waiting list.

Date*

Date Format: MM slash DD slash YYYY

Payment Method

Debit/Credit Card

Registration for all classes must be paid for online using the Debit/Credit Card option at the time of registration. If payment is not successful, a place in class will not be saved and registration will be automatically voided so someone else may register. Please monitor your debit/credit card or PayPal account to be sure that payment was successful.